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		<h3>Internship Request Form</h3>
<table>
<form action="internship-request.php" method="POST">
<font color='red'>* = Required</font>
<tr>
<td> <strong>Company Information </strong></td>
</tr>
<tr>
<td><font color='red'>*</font>Company Name:</td>
<td> <INPUT TYPE='text' NAME='Company' VALUE='' size='25' maxlength='50' /></td>
</tr>
<tr>
<td>Existing Company</td>
<td> <select>  <option value="x">x</option>
               <option value="y">y</option>
     </select> </td>
</tr>
<tr>
<td><font color='red'>*</font> Address:</td>
<td> <INPUT TYPE='text' NAME='Address' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> </td>
<td> <INPUT TYPE='text' NAME='Address' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td><font color='red'>*</font> City:</td>
<td> <INPUT TYPE='text' NAME='City' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> State:</td>
<td> <select>  <option value="MA">MA</option>
               <option value="ME">ME</option>
			   <option value="NH">NH</option>
			   <option value="VT">VT</option>
     </select> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Zip Code: </td>
<td> <INPUT TYPE='text' NAME='Zip' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> Organization Description:</td>
<td><textarea cols="40" rows="5" name="desc"> </textarea></td>
</tr>
<tr>
<td> <strong> Contact Information </strong> </td>
</tr>
<tr>
<td> <font color='red'>*</font> First Name: </td>
<td>  <INPUT TYPE='text' NAME='FirstName' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Last Name: </td>
<td>  <INPUT TYPE='text' NAME='LastName' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Email Address: </td>
<td>  <INPUT TYPE='text' NAME='Email' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Phone Number: </td>
<td>  <INPUT TYPE='text' NAME='PhoneNumber' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td>Extension: </td>
<td>  <INPUT TYPE='text' NAME='Extension' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td>Fax Number: </td>
<td>  <INPUT TYPE='text' NAME='Fax' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <strong> Internship Position Information </strong> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Position Title: </td>
<td>  <INPUT TYPE='text' NAME='PositionTitle' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Number of Positions: </td>
<td>  <INPUT TYPE='text' NAME='Number' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Availability: </td>
<td>  <select> <option value="select">Select a Value</option>
               <option value="Fall">Fall (September-December)</option>
               <option value="Spring">Spring (January-May)</option>
			   <option value="Summer">Summer (May-August)</option>
			   <option value="On-Going">On-Going</option>
     </select> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Pay Rate: </td>
<td>  <select> <option value="select">Select a Value</option>
               <option value="Paid">Paid</option>
               <option value="Un-Paid">Un-Paid</option>
     </select> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Duration of Position: </td>
<td>  <INPUT TYPE='text' NAME='duration' VALUE='' size='25' maxlength='50' /> </td>
</tr>
<tr>
<td> <font color='red'>*</font> Responsibilities:</td>
<td><textarea cols="40" rows="5" name="responsibilities"> </textarea></td>
</tr>
<tr>
<td> <font color='red'>*</font> Qualifications:</td>
<td><textarea cols="40" rows="5" name="qualifications"> </textarea></td>
</tr>
<tr>
<td> Instructions for Application:</td>
<td><textarea cols="40" rows="5" name="intstructions"> </textarea></td>
</tr>
<tr>
<td> Questions or Comments:</td>
<td><textarea cols="40" rows="5" name="questions"> </textarea></td>
</tr>
<tr>
<td>  </td>
<td> <input name="submitButton" type="submit" class="submitContact" value="Submit" /> </td>
</tr>
</form>
</table>
		
		
		
		
		
		
		
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			<h4>About us</h4>
			<p>The goal of the internship program at UNH Manchester is to provide students with hands-on work experience that will enhance their degree and help prepare them for a successful career.</p>
			<h4>Links</h4>
			<ul>
				<li><a href="http://www.unhm.unh.edu/current-students/academics/index.php" title="Current Students Academics">Academics</a></li>
				<li><a href="http://www.unhm.unh.edu/current-students/academic-support-services/index.php" title="Academic Support Services"> Academic Support Services</a></li>
				<li><a href="http://www.unhm.unh.edu/current-students/administrative-student-services/index.php" title="Administrative Student Services">Administrative Student Service</a></li>
				<li><a href="http://www.unhm.unh.edu/current-students/technology-resources/index.php" title="Technology Resources">Technology Resources</a></li>
				<li><a href="http://www.unhm.unh.edu/current-students/library/index.php" title="Faculty & Staff - Library">Library</a></li>

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		<p>Copyright Iternship2Career 2011</p>
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